Fans were missing linebacker Ray Lewis at the end of the Ravens' last game. Lewis is out for the season after suffering a triceps tear, a rare injury with a long recovery time. Dr. Umasuthan Srikumaran, assistant professor of orthopedic surgery at the Johns Hopkins University School of Medicine, said triceps tears are significant injuries for athletes.

The triceps is the muscle on the back part of your arm. It originates from the shoulder blade and the upper portion of the arm, crosses the elbow joint, and inserts into the ulna, a bone in your forearm. The triceps is primarily responsible for extending and straightening the elbow and forearm, and a triceps tear generally refers to the separation of the tendon that holds the muscle to the bone at or near the elbow. A significant force is required to completely tear away the triceps tendon, which typically occurs in a traumatic fall onto the arm or among players in sports such as weight lifting and professional football. In the general population, triceps tears are quite rare, but such factors as steroid injections, anabolic steroid use, underlying medical disease (metabolic disorders) and olecranon bursitis can increase the risk of partial or complete tears.

Not all triceps tears are the same. Some tears are partial or small in size, and may be chronic in nature, while others are complete and sudden. Complete tears with functional disability are managed with surgical repair or reconstruction of the tendon. Partial tears may be treated nonsurgically, particularly if there is not a significant loss of function or notable pain. Nonsurgical treatment involves rest, icing, pain medications, temporary splinting or bracing, and physical therapy. In high-demand individuals such as professional athletes, partial tears may also require surgery if conservative measures fail, or if there is a functional deficit. The best treatment is tailored to each patient, taking into account characteristics of the tendon tear as well as the patient's functional level, goals and expectations.

How long does it take to recover after repair of a triceps tear, and what is involved in rehabilitation?

Immediately after surgical repair, the arm is immobilized in a splint or brace for about two weeks. After this, physical therapy is initiated to help slowly regain elbow motion. Initially only gentle exercises are allowed so that tendon healing is not disrupted. Around four to six weeks after surgery, active motion exercises, done without assistance of a physical therapist, are started. Once full range of motion is restored, strengthening exercises can begin, usually at four to six months after surgery. Most patients can expect to recover close to their full range of motion and strength at a year after surgical repair.

What factors can make it more difficult to treat triceps tears?

When the triceps tears at the junction of the muscle and the tendon, instead of at the tendon-bone interface, surgical management is more difficult. If the tear is not fixed within six to eight weeks from the time of injury, surgical repair is also more challenging. The quality of the tissue may be poor in these cases, and more advanced surgical techniques are often required. In addition to attempting a direct repair, autograft tissue such as hamstring tendon may be needed to augment tendon reconstruction.

How bad an injury is a triceps tear for an athlete?

Complete triceps tears are a significant injury for any athlete. In addition to placing serious limitations on their athletic goals, these tears can also cause significant disability in normal day-to-day activities, such as the simple act of pushing oneself up from a seated position. Even when tears are diagnosed and treated soon after injury, rehabilitation can be lengthy and result in long-term functional deficits. However, some weight lifters and professional football players have been able to return to play after surgical repair of a triceps tear.

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